Wiki New -PT modifier requirements

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nsteinhauser

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Good morning,
Has anyone recently come up against using the -PT for Medicare plan screening colonoscopy turned diagnostic?
Transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Transmittals/r11304cp
Page 47 = "Implement new edit of 120 (Incorrect reporting of modifier PT) in the processing logic for modifier PT for colorectal cancer screening when modifier PT is reported incorrectly with only one line within the defined surgical range (10000-69999 or 0000T-9999T)"
Our Medicare contractor (NGS) is directing our clearinghouse to deny everything with a -PT unless there are 2 colon codes on the claim. If you end up with only one 'screening turned diagnostic' code on your claim, like a 45385 -PT, for instance, you have to resubmit with first a G0121 -PT or G0105 -PT on the first line and then the 45385 on a second line. So adding an additional screening code with the -PT. We are trying to find out more information on this so if anyone hears anything, please share. We can't (yet) access the internal transmittal document but NGS is saying that is the way we have to code now. Seems like a major change for no articles or other CMS information.
Thanks!
 
nsteinhauser said:
Good morning,
Has anyone recently come up against using the -PT for Medicare plan screening colonoscopy turned diagnostic?
Transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Transmittals/r11304cp
Page 47 = "Implement new edit of 120 (Incorrect reporting of modifier PT) in the processing logic for modifier PT for colorectal cancer screening when modifier PT is reported incorrectly with only one line within the defined surgical range (10000-69999 or 0000T-9999T)"
Our Medicare contractor (NGS) is directing our clearinghouse to deny everything with a -PT unless there are 2 colon codes on the claim. If you end up with only one 'screening turned diagnostic' code on your claim, like a 45385 -PT, for instance, you have to resubmit with first a G0121 -PT or G0105 -PT on the first line and then the 45385 on a second line. So adding an additional screening code with the -PT. We are trying to find out more information on this so if anyone hears anything, please share. We can't (yet) access the internal transmittal document but NGS is saying that is the way we have to code now. Seems like a major change for no articles or other CMS information.
Thanks!
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We are getting the exact same edit and even in our encoder it indicates with an edit that we should not be coding 45385 with Modifier PT when alone. I am in AZ and have reached out to our Billing Department to try to get us additional information. I have not able to find anything on this like you mentioned either for clarification from CMS or elsewhere. Was looking for more answers as well.
 
Thanks mconnor. I found the same thing. I hope that our CMS contractor (NGS) got the updated message that the edit is WRONG and will remove it from their software. We're resubmitting.
 
Any further direction? I have been researching this and the data files I've reviewed for July show that 45385 is ok. But, yet, we are getting the edit, and billing is still having all kinds of trouble.
 
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